Provider Demographics
NPI:1568690865
Name:MULUKUTLA, SURYA NARAYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SURYA
Middle Name:NARAYAN
Last Name:MULUKUTLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2646
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-2646
Mailing Address - Country:US
Mailing Address - Phone:956-362-5650
Mailing Address - Fax:956-362-2599
Practice Address - Street 1:2821 MICHAELANGELO DR STE 102B
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1411
Practice Address - Country:US
Practice Address - Phone:956-362-5650
Practice Address - Fax:956-362-2599
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP4683207RE0101X, 2080P0205X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX374872501Medicaid